SURGICAL-MANAGEMENT OF IATROGENIC FACIAL-NERVE INJURIES

Surgical management of an iatrogenic facial nerve injury represents a significant challenge for the otologic surgeon. The decision to perfor m facial nerve grafting is a difficult one and is based on the extent of injury to the nerve. We conducted a review of 22 patients who had s ustained iatrogenic facial nerve injuries during otologic surgery that required surgical exploration. the facial nerve was transected more t han half its diameter in 13 of the patients. All of these patients' ne rves were repaired either with direct reanastomosis of the facial nerv e or with a cable nerve graft. The transection was less than 50% in ni ne of the patients in the study group. Eight of these patients underwe nt only decompression of the facial nerve. No patient with a neural re pair (direct anastomosis or cable graft) had better than a House grade III result. All of the patients undergoing direct anastomosis of the nerve obtained a House grade III result. The most common result in pat ients undergoing cable nerve grafting was a House grade IV. The only p atients with normal or near-normal facial nerve function (House grade I or II) had only decompression of the facial nerve. Five of the eight patients undergoing decompression had results similar to those underg oing cable nerve grafts. We conclude that acceptable results can be ob tained when the facial nerve is repaired by direct anastomosis or a ca ble nerve graft. These results are comparable with those of patients t reated with decompression only. When in doubt as to the extent of inju ry it is preferable to repair the facial nerve, because the extent of injury may be underestimated.